Discrimination between benign and malignant testicular lesions using volumetric apparent diffusion coefficient histogram analysis

Abstract

Purpose: This study aimed to evaluate the role of volumetric apparent diffusion coefficient (ADC) histogram analysis in discriminating between benign and malignant testicular masses.

Methods: In this retrospective study, fifty-nine patients with 61 pathologically confirmed testicular masses were consecutively enrolled, including 18 benign lesions and 43 malignant lesions. All patients conducted preoperative magnetic resonance imaging (MRI) with diffusion-weighted imaging. Eighteen volumetric histogram parameters were extracted from the ADC map of each lesion. Comparisons were conducted by an independent t-test or Mann-Whitney U test, where appropriate. The classification performance of the parameters that showed significant differences between benign and malignant testicular disease were evaluated via receiver operating characteristic (ROC) curve analysis.

Results: Among the 18 histogram parameters we extracted, the energy, total energy, and range of ADC of testicular malignancies were all significantly increased compared with those of benignities. The minimum ADC and 10th percentile ADC of testicular malignancies were both significantly reduced compared with those of benignities. The minimum ADC value achieved the highest diagnostic performance in distinguishing between testicular benignities and malignancies, with an area under the ROC curve (AUC) of 0.822, sensitivity of 81.40 %, and specificity of 77.78 %.

Conclusions: Volumetric ADC histogram analysis might be a useful tool to preoperatively discriminate between benign and malignant testicular masses.

Keywords: Apparent diffusion coefficient; Diffusion-weighted imaging; Histogram analysis; Testicular disease.